DOMAINS and COMPETENCIES REQUIRED TO BECOME A BCS-ASD
According to the Center for Disease Control about 1 in 59 children are being identified with an ASD (CDC, Surveillance Year 2018). Autism occurs in all racial, ethnic, and socioeconomic groups and is four to five times more likely to occur in males. There are current estimates that there are 1.5 million Americans with ASD and it is the fastest growing developmental disability with a greater than 600% increase over the last two decades. Only slightly over half of individuals with ASD graduate from high school and only 4-11 percent gain employment. Although many children with ASD have certain genetic or chromosomal conditions, there is no known cause of autism at present. Additionally, there is no known cure, but many empirically-validated evidence based interventions have greatly improved the prognosis.
The National Research Council reported that most practitioners complete their graduate programs receiving minimal training in evidence-based practice that includes individuals diagnosed with ASD. Studies indicate that there is a clear problem with the currently accepted training models for special education, and that graduate level courses and in-services at the school sites need to emphasize the importance of using evidence-based practices (Dybvik, 2004; Loiacono & Valenti, 2010; Zweigenbaum et al, 2015). As well, there is a need for increased collaboration, particularly in the school settings, in order to provide a meaningful education for students with ASD and for parent education and parent training. Because this specialized training in ASD for implementing evidence-based practices impacting multiple areas of communication related function is lacking in pre-professional programs, a specialization area in ASD is especially important. Clearly, there is a critical need for improved training and intervention to support the needs of people with ASD and their families.
To be specific, the proposed specialization will address the following areas that are not generally covered in SLP graduate programs nor are they currently available through other specialization training:
- Improving speech, language and social communication outcomes for children, adolescents, and adults with ASD that more often than not, isolate themselves or are socially isolated by the community (Koegel, Ashbaugh, Koegel, Detar, & Regester, 2013).
- Using developmental and learning theory frameworks to assess and support development of communication related skills in people with ASD.
- Decreasing severe disruptive behaviors, such as tantrums, aggression, and self-injury that have a communicative function and are common in children with ASD (Beavers, Iwata & Lerman, 2013; Durand, & Carr, 1991).
- Addressing repetitive behaviors and using specific interests to promote social communication (Koegel, Fredeen, Kim, Danial, Rubinstein, & Koegel, 2012).
- Improving prosody, conversation skills, and associated pragmatic-social skills in children, adolescents, and adults with ASD (Koegel, Frea, Surratt, 1994).
- Teaching language functions (such as initiations) in children, adolescents, and adults with ASD (Goldstein, 2002) using verbal and/or nonverbal communication (ie, AAC).
Speech and language intervention is a core need in autism and the most highly utilized intervention. The speech-language pathologist is often the first to see a child with autism, as parents frequently first notice a disability when the onset of speech is delayed (Camarata, 2014; De Giacomo, & Fombonne, 1998). Thus, speech and language services are one of the first referral services children with autism receive. Increased competence through specialty certification will enable SLPs to lead teams of interventionists as well as to supervise practitioners. Currently individuals certified as a Board Certified Behavior Analyst (BCBA) operated by the Behavior Analyst Certification Board (BACB) have specialty recognition for managing behavioral challenges in ASD, but there is a void in the field for specialty certification as applied to the comprehensive and extensive communication and social needs of people with ASD.
DOCUMENTATION: Area of specialization has mechanisms for the acquisition and evaluation of the required post-CCC knowledge, skills, and experience.
The Certificate of Clinical Competence (CCC) knowledge and skills SLPs already has demonstrated expertise in will enhance the acquisition of skills for the autism specialty area. A partial list of these includes knowledge of test administration and speech/language assessments, ability to collect and interpret language samples, the knowledge of developmental milestones for speech, language, and other nonverbal communicative areas, and a detailed knowledge of the anatomical and physiological mechanisms supporting speech/language ability to name a few.
The following areas are critical for the specialization in autism and post-CCC knowledge and will require additional coursework/on-line training and supervised practicum hours. These competencies were presented at the 2015 and 2016 ASHA conferences in Denver, Colorado and Philadelphia, Pennsylvania for feedback. A large number of ASHA members attended these symposiums and provided feedback. Comments were considered and changes addressing the feedback from ASHA members’ have been included. As well, there was an open comment period on the ASHA website and we were provided with the peer survey results in December of 2016 and included relevant feedback into this manual.
During the comment processes, members identified additional training needs that cover both assessment and intervention for individual with ASD. Member identified training areas include treatment procedures in the following:
- Speech Development
- Language Development
- Social Communication Skills
- Communication Related Restricted and Repetitive Behaviors (RRBs)
- Communication Related Self-injurious behaviors (SIB)/Aggression that interferes with learning social communication and community participation
Assessment will include differential diagnosis of autism spectrum disorder, language delays, hearing impairment, social communication disorder, childhood apraxia of speech, dysarthria, expressive and receptive language, social (pragmatic) communication disorder, and speech (phonological) disorder. It will also require an understanding of the DSM, education regarding some of the widely used measures and procedures for the clinical assessment procedures for ASD, understanding functional learning assessment, recognizing pre-linguistic markers, observing in natural environments especially with peers, and gathering and interpreting and integrating information from multiple sources (e.g., physicians, psychologists, special education personnel and other school staff, teachers, academic records, etc.).
Age groups that will be targeted include infants/toddlers, preschoolers, elementary school aged children, adolescents, the transition between adolescence to adulthood, and adults.
In regard to treatment, a comprehensive understanding of evidence-based approaches developed and utilized by SLPs (e.g., Developmental Approaches and Operant/Learning Theory Approaches and issues of generalization such as SCD and autism, parent/family education, understanding a parent’s “state of mind” (e.g., stress), functional analysis, self-management, restricted interests, developing and teaching communication based replacement behaviors when indicated. Treatment will include the knowledge of developmental and operant/learning theory evidence-based strategies across the age range, from infancy through adulthood and will also address a variety of functioning levels including those with the greatest support needs to those with mild support needs.
Those holding the BCS-ASD will also be knowledgeable in the education of other professionals, supporting implementation for treatment as carried out by interventionists with varied backgrounds (e.g., parents, aides, in-home therapists), patient management or coordination of needs, and implementation in varied service delivery models, i.e., treatment delivery across settings (e.g., home/school/community/hospitals/centers/Universities), parent education, and supervision of insurance-reimbursed services related to communication in ASD.
An individual may apply to the American Board of Autism Spectrum Disorder to become a Board Certified Specialist in Autism Spectrum Disorders by complying with the following Standards for Certification.
Preparatory competencies and activities required for the Board Certified Specialist in Autism:
1.a Hold a current Certificate of Clinical Competence (CCC) in Speech-Language Pathology.
1.b Have relevant content (either pre or post CCC) that can be satisfied either through approved coursework or board recognized online training in the following areas (please note that all hours listed refer to seminar/in class hours):
- Understanding the process and procedures for assessment and intervention from developmental and operant/learning theory frameworks (including the below) – (24 seminar hours/2.4 CEU credits)
- Terminology and techniques associated with evidence based assessment and intervention of communication related aspects of ASD.
- Information gathering from multiple sources, including assessing developmental abilities, interviewing key stakeholders such as family members and teachers, identifying communication related intervention goals and effective, evidence based intervention procedures, establishing appropriate data recording methods for accountability, etc.
- Understanding developmental processes in ASD related communication domains, including speech, language and social skills as well as behavioral manifestations of nonverbal communication.
- Principles of Evidence Based Practices, including systematic reviews and a review of the current ASHA evidence maps for autism (6 hours/.6 CEU credits)
- Autism specific assessment procedures (12 hours/1.2 CEU credits) and differential diagnosis
- Autism specific intervention procedures (24 hours/2.4 CEU credits)
- Common comorbid disabilities including ADHD, anxiety, and depression (4 hours/.4 CEU credits)
- Specific considerations in ethical issues related to patient and family rights, intervention procedures, reporting procedures, humane responses to aggression, prohibited use of restraint and aversive procedures such as electric shock, etc. (2 hours/.2 CEU credits)
- Cultural issues and sensitivity in relation to autism, including bilingual issues (2 hours/.2 CEU credits)
- Parent education and supervision of autism clinicians (12 hours/1.2 CEU credits)
- Have 3 years of full-time employment with predominately autism related services with at least 450 documented contact hours attested by a supervising SLP holding BCS-ASD.
- Document advanced educational experiences related to common standardized tests used for autism and behavioral assessment and selecting evidence-based intervention strategies. SLP Domains in addition to speech, language and social skills that can be included are:
- Reduction of over-sensitivities that interfere with communication and socialization (desensitization)
- Reduction of autism related feeding disorders that interfere with social communication
- Measurement of behavior and interpreting and displaying behavioral data
- Data collection procedures
- Graphing data
- Analyzing and interpreting data
- Demonstrate advanced knowledge, skills and supervised practicum in autism***
- Minimum of 25 hours in assessment
- Minimum of 25 hours in birth – 3 years
- Minimum of 25 hours in 3-6 years of age
- Minimum of 25 hours in 7-12 years of age
- Minimum of 25 hours in adolescence (middle and high school) and adult
- Have education in supervision of practitioners (undergraduate and B.A. level clinicians). Because we anticipate that SLPs certified in this area will be eligible to supervise a team of treatment providers, approved coursework or online training in supervision is required.
- Pass a written exam demonstrating competency in autism
***Based on feedback from our open comment period, petitioners may request a limited age range of clients for their practicum hours if their practice is limited. The certification will indicate that the practicum hours were accrued in the limited age range. While we recommend the broader experience, if SLPs work in an early intervention setting that does not have a wide age range, this will not preclude a more limited certification. In cases where the experience is limited to one age group (Preschool, School Age, Adolescent/Adult), certification will be granted with the age level will be designated on the certificate. For example, the certification will indicate the limited age range in which the applicant is certified (e.g., preschool, adult, elementary school-aged).
- In addition, competencies for board certified members include:Integrate multiple sources of information (e.g., review of case history, cultural factors and language differences; and previous evaluation and treatment records; consultation with family members, teachers, and other professionals regarding concomitant or related diagnoses) to support a comprehensive, multidimensional, differential assessment for ASD.
- Conduct a multidimensional assessment by administering informal and formal measures of behavioral, cognitive, affective, social, and linguistic components related to Autism Spectrum Disorders, social/social communication, and other speech, voice and language factors in order to diagnose and plan treatment.
- Interpret informal and formal measures of behavioral, cognitive, affective, social, and linguistic components related to Autism Spectrum Disorders/social/communication/behavior difficulty to determine the overall life impact of the problem and the client’s strengths, coping strategies, resources, and supports.
- Analyze assessment results to deferentially diagnose disorders (e.g., expressive language disorder, social communication disorder) from ASD and other possible diagnoses (e.g., apraxia of speech, difficulties with organization of discourse, and language differences) to ensure effective treatment.
- Recognize both communicative and non-communicative needs (e.g., medical, psychological, developmental, primary sensory [hearing, vision]) and identify when to refer the client for further consultation, assessment and/or treatment.
- Communicate evaluation findings as they relate to the client’s environments (e.g., home, academic, social, cultural, professional) in a sensitive manner that ensures understanding by the client, stakeholders and other professionals.
- Develop, implement and modify differential treatment plans and rationales based on evidence-based guidelines, the client’s evolving needs, and treatment outcomes for individualized treatment.
- Develop, implement and modify an appropriate long-term treatment plan, follow-up and maintenance to promote long-term change.
Completion of Certification: For the BCS-ASD members are required to submit the following:
- Curriculum Vita
- Completion of clinical hours signed by a BCS-ASD SLP
- Transcripts and/or certificates documenting approved coursework and/or online training
PROFESSIONALISM: Maintain competence and ethical practice
2.a Remain current in research by reviewing professional and academic literature for the purpose of informing practice and maintaining specialty certification.
2.b Engage in professional development activities in autism spectrum disorders and other related topics (e.g., attend professional conferences, read research, participate in continuing education, complete coursework) for provision of current and high-quality services reflecting best practice to clients and the community.
2.c Adhere to the ASHA Code of Ethics by reviewing current and updated standards to ensure ethical practice and to provide a model for best practice and professionalism.
2.d Advance evidence-based practice by consulting with professionals in related fields in order to ensure cross-discipline best practice for clients with Autism Spectrum Disorders.
LEADERSHIP: Education, mentoring and/or supervision of professionals and/or students who work with clients.
3.a Educate speech-language pathologists and/or students about the nature, evaluation, and treatment of Autism Spectrum Disorders through teaching, conducting in-services and providing resources.
3.b Supervise graduate students, clinical fellows and support personnel commensurate with their status through observing, modeling and providing feedback to increase knowledge about, and skills in, evaluation and treatment.
3.c Mentor speech-language pathologists through modeling, sharing resources, and providing feedback to advance knowledge and skill development.
3.d Consult with speech-language pathologists, and other stakeholders (e.g., teachers, support personnel, administrators, caregivers, employers, workers and other professionals) to customize goals and treatment methods and develop accommodations to enhance treatment outcomes.
3.e Collaborate with organizations (school district, hospital, clinic or agency) to create innovative service delivery programs in order to enhance treatment outcomes.
ADVOCACY: Education of stakeholders and public about Autism Spectrum Disorders on behalf of clients and/or population and provision of client support.
4.a Educate caregivers, family members, teachers, administrators, support personnel, employers, and other professionals (e.g., physicians, special educators) about the nature of Autism Spectrum Disorders and the value of treatment in a variety of ways (e.g., presentations, publications, consultation) in order to garner support and resources for meeting client needs.
4.b Educate third party payers about the nature of autism spectrum disorders and the value of treatment in a variety of ways (e.g., correspondence, documentation) in order to obtain funding for services.
4.c Educate the public about the nature of Autism Spectrum Disorders and the value of treatment in a variety of ways (e.g., presentations, publications, media) in order to promote awareness, support early identification, and improve the social, academic and work environments of individuals with Autism Spectrum Disorders.
4.d Provide strategies (e.g., expressing rights, needs, solutions; appealing decisions) to families and clients that reflect current legislation, policy and regulations to promote successful self-advocacy.
4.e Recommend and secure customized care to facilitate innovative service delivery options (e.g., providers, frequency, contexts) to meet individual needs of clients.
4.f Identify and support governmental and social policies by communicating with policy makers in order to support best practices for individuals with Autism Spectrum Disorders.
Procedures for Certification of the First Cohort of Currently Certified Speech Pathologists
Currently certified speech pathologists can petition for Board Certification in Autism Spectrum Disorders (BC-ASD) until December 31, 2021. Petitioners must fulfill the content requirements for BCS-ASD including the knowledge and practicum requirements with the following modifications.
- Practicum requirements can be fulfilled by providing evidence of significant clinical experience of not less than three years in the assessment and treatment of Autism Spectrum Disorders. Applicants must submit a written statement of work experience and clinical practicum, which will be reviewed by the certification committee. If the committee determines that the applicant does not meet the criteria, a written review will be provided with a description of the additional practicum required for Board Certification. The applicant must complete these requirements within three years of the committee response (or within the time period specified in the letter) and must be current on fees and on additional clinical requirements during this time.
- Skills and Knowledge requirements can be fulfilled by providing evidence of coursework, clinical-translational research experience and/or continuing education. Applicants must submit a written statement of educational background and experiences that meet the knowledge and skills requirements. This statement and supporting documentation will be reviewed by the certification committee. If the committee determines that the applicant does not meet all of the knowledge and skills criteria, a written review will be provided with a description of the additional competencies required for Board Certification. The applicant must complete these requirements within three years of the committee response (or within the time period specified in the letter) and must be current on fees and on additional CEU requirements during this time.
- Applicants in the entering cohort need not be supervised by another expert in ASD, but there must be a record of professional assessment and intervention experience. This can be documented by letters of support and a work cite record with documented “hands on” experience. Similarly, there must be a clear academic and/or CEU record that the content knowledge has been acquired. For example, coursework or CEU credits in general psychology, social work, or child development that is not related to communication needs of ASD cannot be counted towards the BCS-ASD. Similarly, coursework or CEU credits for approaches to ASD treatment that are not evidence based cannot be used to fulfill the content knowledge requirements for the BCS-ASD. This exclusion also applies to practicum requirements, assessment and/or treatment that is not evidence based do not fulfill the BCS-ASD practicum requirements.